Provider Demographics
NPI:1184716672
Name:SUN MEDICAL EQUIPMENT INC
Entity type:Organization
Organization Name:SUN MEDICAL EQUIPMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICER OF THE CORPORATION
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAHZADA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAQOOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-307-8090
Mailing Address - Street 1:1915 REDLANDS BLVD.,
Mailing Address - Street 2:SUITE #101
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-3350
Mailing Address - Country:US
Mailing Address - Phone:909-307-8090
Mailing Address - Fax:909-307-8099
Practice Address - Street 1:1915 REDLANDS BLVD
Practice Address - Street 2:SUITE #101
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3350
Practice Address - Country:US
Practice Address - Phone:909-307-8090
Practice Address - Fax:909-307-8099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103666332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5227230001Medicare NSC